Healthcare Provider Details

I. General information

NPI: 1235366287
Provider Name (Legal Business Name): ANGELA B. HACKMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ALBANY ST SUITE 807
BEECH GROVE IN
46107-1555
US

IV. Provider business mailing address

PO BOX 664053
INDIANAPOLIS IN
46266-4053
US

V. Phone/Fax

Practice location:
  • Phone: 317-783-8921
  • Fax: 317-782-6916
Mailing address:
  • Phone: 317-783-8921
  • Fax: 317-782-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number1235366287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: